A 63-year-old man underwent Y-graft (16×8 mm Hemashield Gold^®) replacement for an abdominal aortic aneurysm in our department in December 2008. In December 2010, the patient was given a diagnosis of right hydronephrosis in another department, for which a right ureteral stent was placed. The condition was resolved and the stent removed in July 2011. Thereafter in October, the patient developed abdominal distension and macroscopic hematuria. Under a diagnosis of recurrent right hydronephrosis, another ureteral stent was placed, though macroscopic hematuria persisted. He was referred to our department, and was admitted for detailed examinations and treatment. Contrast-enhanced computed tomography showed no obvious ureteroarterial fistula or contrast media leakage in the ureter. Because of the history of long-term ureteral stenting and prolonged macroscopic hematuria, regardless of the absence of a hemorrhagic lesion in the urinary tract, an ureteroarterial fistula in the anastomotic site of the right prosthetic leg and right common iliac artery was strongly suspected. There were no findings indicating an infectious complication, thus endovascular treatment was performed for hemostasis from a ureteroarterial fistula. We performed endovascular treatment with coil embolization (TORNADO^® 7 mm×3, 5 mm×2) of the right internal iliac artery and a covered stent (fluency plus^® 10 mm×80 mm) placement from the right prosthetic leg to the right external iliac artery, after which the hematuria disappeared. Although long-term outcomes following endovascular treatment for ureteroarterial fistula have not been reported, such treatment is considered to be quick and effective, with a low level of invasiveness, thus it should be considered as an effective therapeutic option for such cases in addition to open surgery.

To identify life−related factors causing increased mortality, 2, 769 rural residents aged 29−77 were investigated through a self−administered questionnaire in 1990. Death certificates and migration information were inspected during the 4.5−year follow−up period. Age, obesity, life attitude, job, marital status, drinking and smoking habits, previous or current illness, and frequency of participation in health examinations were checked during the baseline survey. The person−year mortality rate was higher among irregular participants in health examinations than among regular participants both among males and females. From Cox’s multiple regression analysis, factors with a significantly high hazard ratio (HR) for mortality were irregular participation (HR=2.05), increase of age (HR=1.54, for 10 years), previous or current illness (HR=2.44), unemployment (HR=1.95), and living without a spouse (HR=2.61) for males; and for females they were having previous or current illness (HR=15.21) and living without a spouse (HR=2.94). Thus, irregular participation in health examinations, unemployment and aging showed a relationship with a higher mortality only in males. A previous or current illness and living without a spouse were related in both sexes.
participation ; Health ; Illness, NOS ; livin ; g <3>

We began gastric mass survey at our hospital in May, 1980. During 3 years and 8 months since then, (May, 1980-December, 1983) we performed screening examinations to 16, 341 people by indirect radiography, and checked 2, 824 cases (17.3%) for thorough examination. Among these cases, 2, 083 (73.8%) received endoscopic examination actually, and 55 cases of gastric cancer were discovered. The discovery rate of gastric cancer was 0.336 per cent.
35 cases of these 55 gastric cancer were operated in the surgical department of our hospital. 34 cases were resected (rate of resection was 97.1%) and 33 cases were resected curatively (rate of curative resection was 94.3%). These results were better than that of gastric cancer cases from out-patient clinic of the same period. The results of cases from out-patient clinic of our hospital were: total number of cases 321, resected cases 254 (79.1%), curative resection 189 cases (58.9%), respectively.

Cerebral stroke in rural areas is a very important disease both from medical and social aspects. Among strokes, infarction which occurs most frequently in elderly persons is liable to result from atherosclerosis. And for the development of atherosclerosis, essential hypertension is the most important predisposing factor. Other than hypertension, aging, diabetes mellitus, hyperlipemia, esp. low HDL/Tch ratio, increased hematocrit values, coronary insufficiency, cardiac failure, arythmia, esp. atrial fibrillation, are also accepted important risk factors. Affirmative of such findings, the authors are convinced of the fact that atrial fibrillation which is increasing recently is closely related to both cerebral thrombosis and embolism.
But, in regard to cerebral infarction no signifying or trigger factor, similar to very high blood pressure, that trigger cerebral hemorrhage, is clarified as yet. It is made clear in this connection that cardiac failure predisposed by hypertensive heart disease in old age, assisted by pathophysiological and other environmental conditions, is the important factor. The authors also studied the clinical predisposing parameters and preventive measures about strokes.

Cerebrovascular disease is still considered a serious health problem in Japanese rural areas. The rate of death from the disease is very high. Many clinical and epidemiological studies have been conducted so far. However, they have failed to come up with answers effective for prediction and prevention of the scourge.
As part of the agricultural coop commissioned research project entitled “Study of Cerebral Apoplexy: Its Prediction and Prevention, ” we took a questionnaire survey in 1985-86, to obtain data as regards patients' subjective symptoms, electrocardiographic observations, hematological findings and many others before the onset of cerebral apoplexy. Five medical research institutes affiliated with the national welfare federation of agricultural cooperatives responded to our questionnaire.
As a result, the subjective symptoms that showed stochastically significant increases from one year to three months before the onset of the disease as a whole were fatigue, forgetfulness and insomnia. When it comes to cerebrovascular infarction, shortness of breath, angina, forgetfulness, and nocturia were particularly notable.
All these symptoms are not peculiar to cerebral apoplexy, but it should be noted that these are the warning signals of the killer disease.

Pregnant women with renal disease are at high risk of perinatal complications and renal impairment. Here, we report the outcomes of 4 pregnancies complicated by renal disease diagnosed during pregnancy and the puerperal period. Case 1: Urine test had been positive for protein from 8 weeks of pregnancy, and chronic kidney disease stage G4 was diagnosed at 25 weeks of pregnancy. Renal impairment worsened over time, and cesarean section was performed due to non-reassuring fetal status at 32 weeks of pregnancy. Case 2: Urine test had been positive for protein since before pregnancy, and chronic glomerulonephritis was diagnosed at 15 weeks of pregnancy. Gradual impairment of renal function started at 31 weeks of pregnancy, and the patient had a vaginal delivery at 37 weeks of pregnancy. Case 3: Urine test had been positive for protein since before pregnancy, and hypertension and urine protein were observed since around 26 weeks of pregnancy. Cesarean section was performed due to acute renal failure at 36 weeks of pregnancy. Chronic glomerulonephritis was suspected after childbirth. Case 4: Blood pressure became uncontrollable beginning around 28 weeks of pregnancy, and cesarean section was performed due to sudden worsening of hepatic and renal functions at 31 weeks of pregnancy. Autosomal dominant polycystic kidney disease was diagnosed after childbirth. Pregnancies complicated by renal disease need to be managed carefully with monitoring of blood pressure and renal function. Cooperation with a renal specialist is crucial throughout the perinatal and puerperal periods.

Concomitant occurrence of coronary arterial disease (CAD) with abdominal aortic aneurysm (AAA) is not rare. Combined performance of open surgery (OS) of AAA repair and coronary arterial bypass grafting (CABG) has been reported to be effective as the way to avoid the risk of rupture of the aneurysm and acute coronary syndrome (ACS), while it's highly invasive. We successfully performed a combination performance of endovascular aneurysm repair (EVAR) and off-pump CABG (OPCAB) with the support of an intra-aortic balloon pump (IABP) in 2 cases with AAA and unstable angina pectoris (UAP). It was suggested that this strategy is a reasonable clinical option for the patient with UAP complicated with large AAA.

Background : Persistent endoleak is a major cause of aneurysmal enlargement or rupture after endovascular aneurysm repair (EVAR). Although several reports have described ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy as useful strategies, treatment for type II endoleak after EVAR is controversial. Objectives : We investigated the early results in 5 patients who underwent ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy for type II endoleak. Methods : A>10 mm increase in aneurysm diameter after primary EVAR or a maximum diameter>65 mm serve as indications for intervention for type II endoleak. Under general anesthesia, following transperitoneal exposure of the abdominal aorta, the infrarenal aorta was banded using a tape at the proximal landing zone. After the aorta was opened without clamping, the lumbar arteries were ligated, and a stent graft-conserving aneurysmorrhaphy was performed. Results : The mean interval from the primary EVAR was 47±17 months. The mean operation time was 215±76 min. Blood transfusion was necessary in 4 patients (estimated blood loss 1,260±710 ml). No in-hospital deaths were observed, and the mean postoperative hospital stay was 26±20 days. One patient developed aspiration pneumonia and 1 developed surgical site infection post-surgery. The diameter of the aneurysm changed from 68±8 to 47±5 mm during hospitalization and decreased further to 36±7 mm at the last follow-up. Conclusions : The early results of ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy were favorable. Although this strategy could be useful for aneurysmal dilatation secondary to persistent type II endoleak after EVAR, the indications for this approach should be determined following careful evaluation of the patient's status considering the invasiveness of the procedure.